Stapled ileostomy closure results in reduction of postoperative morbidity

Shelygin, Yu. A.; Чернышов, С. В.; Rybakov, E. G.

doi:10.1007/s10151-009-0550-y

Cited by 49 publications

(72 citation statements)

References 10 publications

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“…The characteristics of the included trials are summarised in Table 1. Two randomised clinical trials (RCTs) [14,15] described their randomisation technique. The former study also described its blinding technique, but Löffler et al [15] had not blinded the patients or surgeons.…”

Section: Resultsmentioning

confidence: 99%

“…To exclude selection bias, we aimed to analyse the data of randomised control trials only. However, one RCT had no leak in their cohort of patients (Hull et al [18]) and a second RCT (Shelygin et al [14])…”

Section: Complications Datamentioning

confidence: 99%

“…Horisberger et al [11] defined leak as when there was radiological with clinical symptoms that lead to re-operation. Eight studies did not provide any definition (Bain et al [17], Balik et al [22], Feinberg et al [8], Löffler et al [15], Shelygin et al [14], Wong et al [5], Hull et al [18], Phang et al [10]). Wong et al [5] did not describe leak as a separate entity but as part of a wider heading of anastomotic complications and therefore, it was not possible to calculate their leak rate.…”

Section: Complications Datamentioning

confidence: 99%

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Hand-Sewn versus Stapled Closure of Loop Ileostomy: A Meta-Analysis

et al. 2018

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Background: Individual trials comparing hand-sewn with stapled closure of loop ileostomy show different outcomes due to lack of statistical power. A systematic review, with a pooled analysis of results, might provide a more definitive answer. This review aimed to compare hand-sewn with stapled anastomotic technique for closure of a loop ileostomy and looked at the effect of bowel resection on the complication rates. Methodology: Relevant studies were identified from MEDLINE, EMBASE and the Cochrane database. All randomised clinical trials, prospective and retrospective studies comparing hand-sewn with stapled closure of loop ileostomy were included. Results: Of the 4,917 patients in 15 identified studies, 3,406 had hand-sewn and 1,511 stapled anastomosis. There was no difference in the rate of anastomotic leak between the hand-sewn (2.93%, 55/1,877) and the stapled group (2.08%, 25/1,202) (OR 0.81, 95% CI 0.43–1.54, p = 0.52, I² = 33%). The rate of small-bowel obstruction was higher in the hand-sewn group (7.03%, 231/3,284) compared to the stapled group (5.58%, 73/1,308; OR 0.69, 95% CI 0.51–0.92, p = 0.01, I² = 0%). There was no difference in the incidence of anastomotic leak and small-bowel obstruction in the hand-sewn anastomosis between patients with or without bowel resection. Conclusions: There was no significant difference in the rate of anastomotic leakage between the hand-sewn and stapled techniques. The rate of small-bowel obstruction was higher in the hand-sewn group. Performance of bowel resection does not significantly increase the incidence of anastomotic leak or small-bowel obstruction.

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Section: Resultsmentioning

confidence: 99%

Section: Complications Datamentioning

confidence: 99%

Section: Complications Datamentioning

confidence: 99%

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Hand-Sewn versus Stapled Closure of Loop Ileostomy: A Meta-Analysis

et al. 2018

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“…However, several studies have recently shown that the difference in equipment cost is offset by the operative time saved when constructing a stapled anastomosis [22,23,24]. Furthermore, the larger luminal diameter achieved following a stapled ileal anastomosis results in significantly decreased rates of postoperative small bowel obstruction and ileus (and their associated costs) when compared to sutured anastomoses [24,25,26]. Therefore, standardizing patients undergoing EC to all receive stapled anastomoses may lead to further cost reductions.…”

Section: Discussionmentioning

confidence: 99%

Cost Analysis of Early versus Delayed Loop Ileostomy Closure: A Case-Matched Study

et al. 2015

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Background/Aims: The optimal timing for the closure of loop ileostomies remains controversial. The aim of the current study was to investigate whether early ileostomy closure (EC) (<2 weeks post-formation) results in significant healthcare savings as against late closure (LC). Methods: Patients with available cost data that underwent EC between January 2008 and December 2012 were compared against matched patients undergoing LC during the same period. Direct hospital costs for the two groups were compared. Results: There were 42 EC patients and 61 LC patients. EC patients had significantly less ileostomy-related complications (p < 0.001) and hospital readmissions (p < 0.001). Operative time (p < 0.001) and operative cost (p = 0.002) were also both significantly less in the EC group. Community nursing costs favoured the LC group (p = 0.047). The EC group had an increased post-closure wound infection rate (p = 0.02). The mean total direct cost per patient was NZD 13,724 (SD NZD 3,736) for EC and NZD 16,728 (SD NZD 8,028) for LC. Representing an average costs saving of NZD 3,004 per patient favouring EC (p = 0.012). Conclusion: Although EC increases the post-closure wound infection rate, EC reduces ileostomy complications, hospital readmissions and operative costs resulting in significant healthcare savings. In order to improve patient outcomes and make EC even more cost effective, efforts should be taken to reduce wound infections.

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“…Routine closure of the stoma can be performed using either a hand-sewn end-to-end anastomosis or various techniques using staples [3][4][5]. The theoretical advance of stapled anastomosis over the other techniques is the potentially shorter operative time and the larger luminal diameter, thereby being less associated with postoperative small bowel obstruction [3].…”

Section: Introductionmentioning

confidence: 99%